The following are highlights of the Champlain Local Health Integration Network (LHIN) Board of Directors meeting held in Ottawa, Ontario on September 28, 2016.
Champlain LHIN Sub-Regions - Decision
Earlier this year, the Ministry of Health and Long-Term Care asked all LHINs to identify sub-regions to better support health system planning and integrated service delivery at a more local level.
The Board of Directors unanimously approved the sub-region boundaries, as presented by James Fahey (Champlain LHIN Director of Health System Planning).
The identified sub-regions were informed by significant community engagement and health system data. In August and September 2016, the LHIN hosted seven community engagement sessions. The first was to provide advice on the engagement process and the draft sub-regions. Five consultations sessions across the region and a targeted consultation with members of the Indigenous Health Circle Forum followed.
All together, 224 people participated in the face-to-face consultation sessions and 122 submitted feedback through an online survey. Eighteen per cent of participants were health consumers and 23 per cent were involved in primary care. Participants shared important and insightful feedback which led to significant changes to the first draft of the potential sub-regions.
In addition to stakeholder feedback, the model for sub-regions considered how people work and live and where they access their family doctor or nurse practitioner. Existing geographies such as public health boundaries, Health Link areas and current networks were also considered.
Sub-regions will enable the LHIN to achieve its mission through better understanding the needs of local residents, planning for more defined populations and a focus on population health equity issues. Through sub-regions, the LHIN and providers will enhance local coordination and system navigation as well as provide better solutions to local problems for the communities they serve. Mr. Fahey noted however, that a number of communities such as Indigenous populations live across the region so planning cannot be limited to a specific sub-region.
As next steps, the LHIN will review initiatives in its Annual Business Plan and Integrated Health Service Plan 2016-19, with an aim of aligning these plans with the sub-regions.
Board members emphasized that while sub-regions are an important tool for population health planning, they will not act as barriers to care for patients, nor negatively affect primary care referral patterns. With sub-regions, people will continue to access care where they choose.
Palliative Care - Education
Enhancing palliative care in settings of choice is a priority of the Champlain LHIN.
There have been a number of successes in palliative care in Champlain, including implementation of the first regional palliative and hospice care program in the province, the development of regional standards and indicators and the creation of Hospice Care Ottawa. Yet, when, on average, only 15-30 per cent of Canadians have access to palliative care services, more needs to be done.
Dr. José Pereira (Director of Research at the College of Family Physicians of Canada and Scientific Officer of Pallium Canada) presented on Pallium’s Learning Essential Approaches to Palliative Care (LEAP), a training course aimed to build capacity among health service providers. “Palliative care is not just about end of life…It is everyone’s responsibility and everyone’s job,” said Dr. Pereira. “If we are going to increase access it is about getting more health care professionals trained in those basic skill sets,” he added.
The LEAP course trains health care professionals in various sectors, including nurses, primary care physicians, long-term care workers, home care professionals and paramedics. Integrating a palliative care approach at the outset is the aim of the LEAP program. With this training, health care professionals involved in the patient’s care will have the knowledge to support a more seamless transition, should their patient reach a palliative stage.
In 2014-15, Pallium hosted 210 courses, training over 8000 health professionals across the country, including a two-day training with staff of the Perley and Rideau Veterans’ Health Centre.
Dr. Pereira challenged the Board members to imagine a health system where all providers are trained in a palliative care approach, and furthermore, where these skill sets go beyond health care into compassionate communities and neighbourhoods. Palliative care is everyone’s business, Dr. Pereira concluded.
Health Needs of Francophones in Champlain - Information
The Champlain LHIN has made it a priority to ensure that health services are timely and equitable. The LHIN works with partners such as the French Language Services Network of Eastern Ontario (Le Réseau) to achieve this goal.
By engaging with communities, Le Réseau has identified a number of pressing needs among Francophones. They include information and coordination of French language services (in particular, access to mental health and additions) home and community care, palliative care and specialized services. These concerns are similar to the findings of the LHIN’s own community engagement.
To address these needs, the LHIN and Le Réseau have focused on the French language service designation of health service providers. Designation serves as a way of ensuring “permanent, quality French language services,” explained Jacinthe Desaulniers (Executive Director of Le Réseau).
The French-language services designation improves access by:
- Building the active offer of French language services into the core of the health care system
- Guaranteeing permanent access to French language services
- Introducing standardized practices for the offer of French language services
- Generating data on the use of French language services.
The LHIN has set local obligations in service agreements with providers related to designation. In addition, health service providers are increasingly aware of language as a social determinant of health. As a result, momentum towards designation is growing and consequently, 49 organizations in Champlain are actively involved in the designation process.
“Through continued effort, designation can reach its full potential,” said Mme. Desaulniers. A capacity analysis of the region reveals there is more work to be done. Many organizations are in the early stages of the process and some agencies continue to work towards their full designation. In addition, French language service capacity remains low in the western part of the region.
What is more, this fiscal year, early results will be available from the Linguistic Variable Pilot Project. This project, involving 21 hospitals in the Champlain and South-East LHINs, collects linguistic data. Mme. Desaulniers explained there is strong interest in this project around the province. With linguistic data, the LHIN will be able to better understand where Francophones are receiving care and the type of care they receive to better plan for their health care needs.
These initiatives support the LHIN’s goal of providing cultural and linguistically appropriate care.
Health Links: Scaling and Sustainability - Information
Cal Martell (Champlain LHIN Senior Director Health System Integration) presented the LHIN’s action plan on the expansion and sustainability of Health Links in the region.
In the Champlain region, 65 per cent of all health care resources are consumed by 5 per cent of the population. Most of these services are hospital-based and costly.
Health Links is an approach that provides better and more efficient coordinated care for these patients with high-needs. At present, 560 patients with high-needs are participating in Health Links and this number is intended to increase to 1,325 patients by the end of the year.
Further, the LHIN aims to escalate the spread of Health Links, with 10,000 patient participants by the end of 2019. This represents a growth of almost 300 per cent each year. “It is, by far, the most ambitious plan for Health Links in the province,” said Mr. Martell.
To scale up Health Links sustainably, the LHIN will largely use existing resources, focusing on health care providers already doing care coordination. As well, the LHIN will approach providers who already serve potential Health Links clients to take on more active care coordination.
Engaging primary care is also a critical factor. Currently, 156 primary care practitioners are participating in Health Links. To meet the goal of 10,000 patients, this number also needs to increase to 900 family physicians within three years.
The LHIN’s Primary Care Engagement Working Group has identified four key strategies to date to accelerate the involvement of primary care in Health Links. These include: a review of existing billing codes to recognize physician time in case conferencing, communication and marketing, physician champions and tasking Health Link primary care physicians to recruit a colleague.
The commitment of all of the key Health Link partners is key to its success.
Health Links aligns with the LHIN’s strategic direction to increase the value of our health system for the people it serves.
Bruyère Performance Plan - Decision
Since last year, the Champlain LHIN has worked with Bruyère Continuing Care to address the hospital’s budgetary pressures and other performance challenges.
As part of its mandate, the Champlain LHIN enters into service accountability agreements with each health service provider it funds. In the agreements, the LHIN and providers agree to a number of targets, including those covering operations, finances, service volumes, quality of care, and wait times.
The LHIN works with providers, monitoring results and taking action to optimize performance for the individual agency and the regional health system.
As per the improvement process described in the Hospital Service Accountability Agreement, Bruyère was asked by the LHIN to develop an improvement plan, which was shared with the Champlain LHIN Board at its meeting on August 24, 2016. The plan described a number of improvements to reduce costs while maintaining care for patients.
After careful deliberation, the Board decided to accept some components of Bruyère’s plan that were already under way and linked to operational efficiencies. However, the Board remained concerned that the plan presented by the hospital would not fully resolve its current financial challenges or its longer-term sustainability.
In addition, Board members did not support a proposal by Bruyère to repurpose funds directed to caring for patients with challenging behaviours as a result of dementia or other conditions. Further discussions between the LHIN and the hospital will follow.
The Board expressed the value of the programs and services provided by Bruyère, and as a result felt this decision was necessary to ensure its sustainability in both the short and long-term for patients and families.
First Quarter 2016-17 Performance Report - Decision
The Board approved the first quarterly performance report for 2016-17. The performance report includes indicators that align with the Integrated Health Service Plan 2016-19. New indicators that are introduced this year include those related to: primary care, Indigenous cultural competency, use of telemedicine, palliative care and Health Links.
Of the 30 indicators included in the report, 14 are determined by the Ministry of Health and Long-Term Care and shared by all LHINs.
For these 14 indicators, during the first quarter of 2016-17, Champlain LHIN was 83 per cent of the way to achieving the Ministry targets. This an improvement of three per cent from a year earlier.
The progress was largely due to a decrease in the time new clients of the Champlain Community Care Access Centre wait for their first home care visit. This metric improved by 29 per cent, from 55 per cent to 84 per cent of the provincial target. Brian Schnarch (Champlain LHIN Director of System Performance and Analysis) cautioned that this improvement may not be sustainable long-term due to increasing demand.
Some indicators proved more challenging. There was some deterioration in repeat visits to the emergency room for people with mental health and addictions; however, the Champlain LHIN is still close to the provincial target.
Achieving the target for MRI wait times for persons with non-urgent conditions continues to be difficult. This trend is seen across the province. There was an improvement from the previous quarter that was largely due to additional one-time LHIN funding to increase operating hours.
The LHIN continues to work with health service providers on strategies to reduce MRI wait times, such a central intake system as well as developing clinical protocols to guide when MRI scans should be ordered.